Forehead/Brow Lift Information provided by La Jolla Plastic Surgeon Dr. Kincaid M.D.

Years of gravity and use can cause the eyebrows to droop or sag and frown lines to form on the forehead. These problems can be treated using forehead/brow lift surgery. This procedure is often coupled with a face lift and/or eyelid surgery to achieve a more youthful appearance.

Procedure
Forehead/brow lift surgery is conducted on an outpatient basis using local anesthesia with sedation. An endoscopic technique has gained popularity for forehead/brow lifts because it is less invasive than traditional surgery and causes less scarring. Small incisions are made behind the hairline and a small instrument with a camera is inserted. Using this device, the surgeon removes any excess skin and tightens and lift the muscle and tissue. Small sutures are used to close the incision. The surgery generally takes 1 to 2 hours.

Any one or combination of the following conditions may indicate that you are a good candidate for a forehead lift:

• sagging or low position of the eyebrows, creating a tired or sad appearance
• deep horizontal creases across the forehead
• frown lines, or furrows, between the eyebrows and sometimes across the top of the nose

A forehead lift can improve all of these problems. It may often be performed at the same time as a facelift which removes excess skin and tightens muscles in the mid and lower face. If there is significant skin overhang in the upper eyelids, or puffy bags beneath your eyes, eyelid surgery may be recommended in addition to a forehead lift. Your plastic surgeon will provide further information if you have an interest in these procedures.

Face Lift Information provided by La Jolla Plastic Surgeon Dr. Kincaid M.D.

A facelift (technically known as rhytidectomy) can’t stop the aging process. What it can do is improve the most visible signs of aging by removing excess fat, tightening underlying muscles, and redraping the skin of your face and neck. Over time, during normal aging or even with weight loss, the face will change resulting in excess skin laxity, joweling, wrinkling and even elongation of the facial skeleton itself compelling patients to seek correction. A face lift helps to restore the more youthful look to your face and neck – smoothing the contours and wrinkles that aging causes. A facelift can be done alone, or in conjunction with other procedures such as a forehead lift, eyelid surgery, or nose reshaping. A facelift usually takes several hours-or somewhat longer if you’re having more than one procedure done. Incisions usually begin above the hairline at the temples, extend in a natural line in front of the ear (or just inside the cartilage at the front of the ear), and continue behind the earlobe to the lower scalp. In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and membrane, pulls the skin back, and removes the excess. Stitches secure the layers of tissue and close the incisions.

How long does a facelift last?
The traditional answer is about 10 years, however, this depends upon various factors such as technique, facial type, quality of skin, sun exposure and, yes, smoking. Despite the fact that the process of aging cannot be stopped, one can expect that they will tend to always look better after a face lift – at any age – than if they never had the procedure at all.

Rhinoplasty Information provided by San Diego Plastic Surgeon Dr. Kincaid M.D.

Some of us are unhappy with our nose, either because of its size or shape or because of breathing problems. Rhinoplasty reshapes the skin as well as the bone and cartilage inside to alter the size and shape of the nose. Work on the cartilage that separates the two nasal air passages can help with breathing problems. This so-called “septoplasty” is often done as part of rhinoplasty or as the sole procedure. Sometimes this same cartilage is also used as a graft to help in the nose reshaping. Rhinoplasty, or nose surgery, is one of the most common of all plastic surgery procedures. Rhinoplasty can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. Rhinoplasty usually takes an hour or two, though complicated procedures may take longer. During surgery the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. Finally, the skin is redraped over the new framework. Many plastic surgeons perform rhinoplasty from within the nose, making their incision inside the nostrils. Others prefer an “open” procedure, especially in more complicated cases; they make a small incision across the columella, the vertical strip of tissue separating the nostrils. When the surgery is complete, a splint will be applied to help your nose maintain its new shape. Nasal packs or soft plastic splints also may be placed in your nostrils to stabilize the septum, the dividing wall between the air passages

Tummy Tuck Surgery in San Diego – San Diego Plastic Surgeon Dr. Kincaid M.D.

Abdominoplasty, known more commonly as a “tummy tuck,” is a surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. Abdominoplasty can dramatically reduce the appearance of a protruding abdomen. Often after pregnancy or weight loss, excess skin and stretch marks deform the once flat and tight abdomen. But, despite diet and exercise, loose skin still remains. Abdominoplasty is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved. The best candidates for a tummy tuck are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin.

What are the incisions used in a tummy tuck?
Tummy tuck surgery or abdominoplasty is the surgical excision of excess skin to the abdomen. An ellipse of skin is removed between the umbilicus (navel) and the hairline of the mons area. This also means that C-section scars are removed as well. This skin above the umbilicus is then lifted off the abdominal wall muscles up to the level of the rib cage and then pulled down to the level of the mons and closed. Before this is done, however, the loose abdominal wall muscles are tightened – which, also narrows the waistline. It does produce a permanent scar.

What is a mini tummy tuck?
In selected patients, a limited skin excision can be performed, which can then be combined with direct liposuction of the abdomen (this is usually not advised in a traditional abdominoplasty as it can significantly compromise the blood supply and increase risks of wound development). The umbilicus is not cut out but only relocated and the abdominal wall is tightened before completing the procedure. Although the scar length is shorter, the final result is usually not as tight and so most candidates for a tummy tuck elect to undergo the traditional abdominoplasty.

Can other procedures be performed with a tummy tuck?
Patients often have multiple procedures at the same time. The most common include breast augmentation, breast lifts and/or liposuction. This saves both time and money since costs are often reduced when multiple procedures are combined. Additional procedures would also include facial cosmetic surgery or those related to weight loss such as thigh or buttock lifts. If you’re considering abdominoplasty, this will give you a basic understanding of the procedure – when it can help, how it’s performed, and what results you can expect.

Smartlipo in San Diego

LaserBodySculptingSM, Laserlipolysis

The Smartlipo^TM is the first laser system designed for LaserBodySculpting^SM and for the disruption of fat cells. It is ideal for treating localized deposits of unwanted fat, fat tissue irregularities and for coagulating tissue leading to a tightening effect.
Smartlipo is ideal for treating small areas of the face, neck, arms, male breasts (gynecomastia), and other areas of loose or lax skin (flabby skin).

How does the Smartlipo work?

Smartlipo laserlipolysis is a minimally invasive surgical procedure. The procedure disrupts the fat cells through a thermal and photodisruptive action – heating and shattering the fat cell membrane. The laser coagulates the underlying vessels due to the hemostatic properties of the laser, resulting in less bleeding, bruising, trauma as well as less down time. As an added benefit, the system has also been reported to promote tissue tightening through bulk thermal heating and tissue coagulation.

The procedure is commonly performed under local and tumescent anesthesia. A laser fiber is introduced through a handpiece and detachable cannula. The cannula is then inserted through a 1 to 2 mm incision in the skin and into fat pockets. The cannula, with the tip of the fiber exposed approximately 2 mm, is then moved in a “back and forth” fanning motion. The laser’s aiming beam can be visualized through the skin, allowing the physician to identify the treatment area. As the fiber tip comes in contact with the fat cells it ruptures the cell membranes and releases the fatty oil from the fat cells. This end product may then be aspirated from the site.

What are the benefits of Smartlipo?

• Treats unwanted fat and fat tissue irregularities
• Promotes tissue coagulation resulting in skin tissue tightening
• Treats flabby or lax skin and areas of high vascularity
• Minimal edema and bleeding due to the laser’s hemostatic properties
• Minimal bruising
• Causes less trauma and faster healing time than traditional liposuction

What type of system is used?

The Smartlipo is an Nd:YAG laser with high peak power and a high rep rate of 40 Hz. The laser energy is delivered using a 300 micron fiber which is threaded through the handpiece and cannula.

Are there disposable costs associated with the procedure?

Laserlipolysis with the Smartlipo system has very few disposable costs associated with the procedure. The handpiece and cannulas are re-usable and would only be replaced due to normal wear and tear. The fiber is warranted by the manufacturer for one use. However, the fiber is a “cut and cleave” design, meaning you could simply continue to trim down the end of the fiber after each case.

Does this procedure have FDA Clearance?

The Smartlipo has been cleared by the FDA for laser-assisted lipolysis. It is also cleared for incision, vaporization, ablation and coagulation of soft tissue.

Who can use the Smartlipo?

Currently, only physicians who have previous liposuction experience are able to purchase the Smartlipo laser. Prior liposuction experience will shorten the learning curve significantly. Those without prior liposuction training and experience should be trained based on the guidelines of the American Academy of Cosmetic Surgery.

How is training for the Smartlipo system handled?
Once a customer purchases the unit, they will receive training on the procedure at a designated Cynosure training site.
Due to the nature of the product and procedure there will be no demonstration of the Smartlipo sytem.

Does laser-assisted lipolysis produce lasting results?
Yes! The Smartlipo procedure permanently destroys the treated fat cells. Adults do not create new fat cells. When a person gains weight, that person’s fat cells simply expand. Should you gain weight, that fat will most likely be deposited in areas where the procedure was not performed.

Who is a good candidate for the procedure?
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Ideal candidates are in good health, close to normal body weight and have realistic expectations for the results. If the person has areas of fat that will not respond to diet and exercise, then that person is a candidate for laser-assisted lipolysis.

How many treatments are required?

For most patients, typically only one treatment is required. The session may last from 45 minutes to one hour for each area treated. Laserlipolysis is also an ideal choice for “touch ups” and revisions.

How can facilities become training sites?

Cynosure is very interested in establishing training sites for the Smartlipo through out the country. The qualified training centers should perform 10-20 liposuction cases per month and be willing to follow Cynosure training guidelines.

How does the Smartlipo compare to the Vaser?

Smartlipo is a laser system with the energy transmitted through the fiber (which is threaded through the cannula) and deposited directly to the tissue, disrupting the fat cells. The laser’s aiming beam allows visualization of the treatment area.

The Vaser is an ultrasonic device that transmits energy throughout the entire probe and not just the tip. The energy is more difficult to control and has been known to cause burns near the incision. The probe is much larger than the laser fiber and requires a larger skin incision.

The company provides the system and all accessories to the customer and charges $500 per procedure with a minimum of 4 procedures per month.

How does the Smartlipo compare to the new ultrasound systems such as Ultrashape or Liposonix?

These systems are non-invasive and deposit focused ultrasound energy that does not differentiate between fat and other structure within the body. Extreme care must be taken to guide the system through out the treatment area. The scanner remembers where the system had fired. For example, the Ultrashape device has a 5 mm spot size used via a scanning mode. A 10×10 cm area can take over one hour to treat.

Liposuction in San Diego

Liposuction or suction assisted lipectomy (SAL) is the process of contouring the body through the removal of fat. A long, hollow, blunt, metal canula (tube) is inserted through small incisions and fat is removed using a vacuum suction devise. This allows sculpting those diet and exercise resistant areas to achieve the figure that you desire. Liposuction can help sculpt the body including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don’t respond to traditional weight-loss methods.

Who are good candidates for liposuction?
The ideal patients are those who are close to their ideal body weight and in good physical condition. Liposuction is not a substitute for weight loss – it is a contouring procedure for areas of the body that are diet and exercise resistant. These would include the abdomen, hips, and thighs in women and the abdomen and flanks in men. The face, breasts, back, and calves are also areas that liposuction can be effective. Finally, the quality of skin can also be a factor since skin retraction will occur after liposuction. In most cases, liposuction can be an excellent procedure with a relatively quick recovery and noticeable improvements in body contour.

What are the different types of liposuction?
Traditional liposuction uses mechanical vacuum assisted aspiration to remove fat through metal canulas. The other commonly used method – ultrasonic liposuction – involves the use of ultrasonic vibration to explode fat cells. The fatty material is then removed by vacuum suctioning. This method generally reduces the overall operative time but there is the risk of burn injury and even permanent irregularities if areas of fat are dissolved where not intended. Another method of liposuction combines traditional liposuction combined with an oscillating canula to help facilitate breakdown and aspiration; this is called power assisted liposuction (PAL).

What are the incisions used in liposuction?
Liposuction uses a number of very small incisions – about ¼ inch each – placed at various sites to allow insertion of the canula. These are often not even closed since they will seal all by themselves and fade to almost nothing in about a year.

San Diego Breast Lift Information provided by Board Certified San Diego Plastic Surgeon

As time passes, all skin looses some of its elasticity. For some women, this leads to breast sagging, which can be severe. Childbearing and nursing contribute to breast sagging. A breast lift is used to restore the shape and firmness of breasts and/or to reduce the size of the areola (the dark area encircling the nipple).

Breast Lift Procedure
Breast lifts are usually conducted on an outpatient basis using a general anesthetic. An anchor-shaped incision is made that goes around the areola, vertically from the areola to the natural crease under the breast and horizontally across the crease under the breast. Excess skin is removed and the areola is repositioned. The incision is sutured closed. A modified procedure is used for women with smaller breasts or with less sagging. In the modified procedure, an incision is made around the areola. All excess skin is removed, the areola is replaced and the incision is closed. The surgery generally takes between 1-1/2 and 3 hours.

Recovery
Following the surgery, a gauze dressing is placed on the breast and covered with a tight elastic bandage or surgical bra. This helps reduce swelling. There is the possibility of infection following any surgery. Your surgeon will likely prescribe antibiotics to avoid infection in addition to any pain medication. Stitches are removed in 3 to 5 days, at which time a softer, support bra is worn over a gauze dressing 24 hours a day for 3 to 4 weeks. Swelling, bruising and numbness, particularly around the incision, are normal and generally subside over 6 weeks. Most patients return to work in 7 to 10 days, but must avoid heavy lifting and strenuous activities for 4 weeks.

Breast Augmentation Information provided by Board Certified San Diego Plastic Surgeon

Am I a good candidate for breast augmentation?

One or more of the following feelings or conditions may indicate that you are a good candidate for breast augmentation:

• you are bothered by the feeling that your breasts are too small
• clothes that fit well around your hips are often too large at the bustline
• you feel self-conscious wearing a swimsuit or form-fitting top
• your breasts have become smaller and lost their firmness after having children
• weight loss has changed the size and shape of your breasts
• one of your breasts is noticeably smaller than the other

Your Personal Consultation

During the consultation, you will be asked about your desired breast size and anything else related to the appearance of your breasts that you feel is important.

This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

How will my ASAPS plastic surgeon evaluate me for breast augmentation surgery?

Your plastic surgeon will examine your breasts and perhaps take photographs for your medical record. He or she will consider such factors as the size and shape of your breasts, the quality of your skin and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). If your breasts are sagging, a breast lift may be recommended in conjunction with breast augmentation.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. You will be asked whether you have a family history of breast cancer and about results of any mammograms. It is important for you to provide complete information.

There is no scientific evidence that breast augmentation increases the risk of breast cancer. The presence of breast implants, however, makes it more technically difficult to take and read mammograms. This may be a special consideration for women who perhaps are at higher risk for breast cancer because of their family history or other reasons. Placement of the implant underneath the pectoral muscle may interfere less with mammographic examination, but other factors may also need to be considered with regard to implant placement. Your plastic surgeon will discuss this with you.

If you are planning to lose a significant amount of weight, be sure to tell your plastic surgeon. He or she may recommend that you stabilize your weight prior to undergoing surgery.

If you think that you may want to become pregnant in the future, you should mention this to your surgeon. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of your breast augmentation. There is no evidence that breast implants will affect pregnancy or your ability to breast-feed, but if you have questions about these matters, you should ask your plastic surgeon.

How will my breasts look and feel after the breast implants have been placed?

A day or two after surgery, you should be up and about. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your plastic surgeon will probably permit you to shower between three and seven days following surgery. Stitches will be removed in about a week.

Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.